Project Summary/Abstract Dental problems are the leading chronic conditions among children in the United States (US) and are more prevalent among children of low socioeconomic status. Dental health plays a key role in the overall health status and quality of life of children and may affect several domains of child development and growth including learning. However little is known about the broader impacts of dental health on children's academic achievement in the United States. A few studies have focused on the relationships between children's dental health and their educational performance. Most studies however have utilized self-reported data on dental health and schooling achievement and those that used objective measures included small samples with limited generalizability. This literature suggests that dental problems are related to worse schooling performance such as lower grades and school attendance. However, this evidence indicates association and not necessarily causal links as it is based on cross-sectional data and suffers from several limitations including the potential for unobservable confounders that can bias the estimates such as household dental care practices and parental style. Finally and perhaps most importantly, practically nothing is known about how seeking preventive dental care prior to school entry and during schooling years impacts educational achievement. We will identify the effects of dental health problems on trajectories of academic achievement of children in Medicaid in Iowa comparing children with dental problems to their unaffected siblings and classmates. Furthermore, we will examine the effects of preventive dental care on academic achievement using similar group comparisons as well as within-child changes over time. Those comparisons control for many potential confounders. Our study employs unique population-based and longitudinal data consisting of linkages between Medicaid enrollment and claims files, birth certificates, and high-quality objective measures of academic achievement based on the Iowa Tests of Basic Skills (ITBS) and the Iowa Tests of Educational Development (ITED), which are administered regularly to virtually all students in Iowa. The sample includes around 40,000 children born between 2000 and 2007 and nearly 300,000 child- grade observations. Our work is highly impactful and innovative in being the first population-based study of the effects of dental health and service use on children's academic achievement in the US using objective measures and longitudinal data that allows tracking children over time to study their achievement trajectories. Identifying the interplays between dental health and academic achievement could ultimately inform the designing of pre-school and school-based interventions focused on dental health assessment and treatment to prevent and reduce learning problems. Furthermore, this knowledge will help to more accurately assess the societal value of policies and programs that improve access to dental care through childhood and adolescence.